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Motor System Upper Limb
Washes hands, appropriate dress and grooming. Introduces self and asks for consent. * Hello my name is Student and I'm a first year medical student at School. * Can I please get your full name and age please? * Mr. Doe my attending physician has asked be to examine the motor system of your upper limb, do I have your permission? Explains procedure to patient, positions and drapes * Today we're going to test the reflex and muscles of your upper limb, are you comfortable with this? * I just want to remind you that anything we find today will be confidential. * Mr. Doe, please sit on the bed. * The patient is properly draped. INSPECTION: Inspect the upper limbs commenting on deformities, length discrepancy, symmetry, muscle wasting, fasciculations, etc. * I'm going to begin by inspecting the upper limb of the patient. * I don't see any deformities. * I don't see any length differences (discrepancy). * I don't see any asymmetry. * I don't see any fasciculations. * I don't see any muscle wasting. * I don't see any wasting of the thenar and hypothenar muscles. * I don't see any resting tremor of the hands which can suggest Parkinson's Disease. * Mr. Doe, please reach over and grab this object in my hands. ** I don't see any intention tremor which can suggest Multiple Sclerosis. TONE: Tests for muscle tone of both upper limbs and comments and findings. Describes what one would expect to find in a central vs a peripheral nervous lesion * Mr. Doe, please relax your arms as much as possible. * Test: ** Shoulder ** Elbow ** Wrist ** Fingers ** Thumb * The patient's muscle tone felt normal. ** Increased resistance can suggest a Central Nervous Lesion. ** Decreased resistance can suggest a Peripheral Nervous Lesion. POWER: Tests for muscle power bilaterally and comment of findings: * Mr. Doe, I'm now going to test your muscle power. * You're going to hold a position and I'm going to try to overcome it. * Please try to keep your arms raised and keep it in that position. * Please try to keep your arms to your side and keep it in that position. * Please keep your arms flexed. * Please keep your arms extended. * Please keep your wrist flexed. * Please keep your wrist extended. * Please spread your fingers and hold it that position. * Please close your fingers and hold it in that position. * Please touch your pinky with your thumb and hold it there. * Please grab my fingers as tightly as you can. * I would rate the muscle power 5, normal power, active movement against full resistance without fatigue. REFLEXES: Elicit reflexes bilaterally and comment on findings. * Mr. Doe, I'll be tapping your arm with this hammer, please relax your arm as much as possible. * Biceps reflex * Triceps reflex * Brachioradialis reflex * I would rate these reflexes as 2+ which is average or normal. Check for a Hoffmann response bilaterally and comment on findings. Describe a positive response and its significance. * I'm not going to test for Hoffmann response by flicking the patient's middle finger. * Mr. Doe show me your hands. * I don't see Hoffmann's sign in either hands. * A positive Hoffmann's sign would be flexing of the fingers or adduction of the thumb. * A positive Hoffman's sign is heightened finger flexor reflexes and can suggest an upper motor neuron lesion. * That's all for your exam today, thank you come coming in.